Recurrent Pericarditis in Children and Adolescents

Abstract

Recurrent pericarditis (RP) is a clinical syndrome characterized by recurrent attacks of acute pericardial inflammation. Prognosis quoad vitam is good, although morbidity might be significant, especially in children and adolescents. Multiple potential etiologies result in RP, in the vast majority of cases through autoimmune or autoinflammatory mechanisms. Idiopathic RP is one of the most frequent diagnoses, that requires the exclusion of all known etiologies. Therapeutic advances in the last decade have been significant with the recognition of the effectiveness of anti IL1 therapy, but a correct diagnostic and therapeutic algorithm is of key importance. Unfortunately, most of evidence comes from studies in adult patients. Here we review the etiopathogenesis, diagnosis and management of RP in pediatric patients.

A computational workflow for the detection of candidate diagnostic biomarkers of Kawasaki disease using time-series gene expression data

“…It has been characterized as an “undiagnosed” type of SAID for which no gene mutation has been identified so far and whose pathogenic mechanism remains unknown. Other examples of such SAID types include the neutrophilic dermatosis [9] , and the recurrent pericarditis [10] .…”

Periodic fever syndromes and the autoinflammatory diseases (AIDs)

“…NSAIDs represent first line therapy for idiopathic pericarditis, with indomethacin (2 ​mg/kg daily, divided every 6–12 ​h) and ibuprofen (30–50 ​mg/kg daily, divided every 6–8 ​h) as drugs of choice; on the contrary, steroids should be avoided and, when necessary, employed at the lowest effective dose [ 193 ]. Furthermore, colchicine, drug extensively used in FMF patients, has shown to decrease recurrences in patients with idiopathic pericarditis and it is frequently administered in combination with NSAIDs [ 193 ]., The AIRTRIP randomized trial demonstrated the efficacy of anakinra in difficult to treat patients with recurrent pericarditis [ 194 ]. More recently canakinumab has been also used in pericarditis [ 195 ].…”

Responses to Treatment According to the Cytokine Profiles of Pericardial Effusion in Two Children with Idiopathic Pericarditis

“…A cute pericarditis (AP) is an inflammation of the pericardium with or without pericardial effusion (PE). [1][2][3][4] The incidence of AP has been reported as 27.7 cases per 100,000 people per year. 1) The etiology is varied and depends on the epidemiological background, patient population, and clinical setting.…”

“…5,6) Treatment options for PE in patients with AP have not been well established because of its unknown pathomechanism. 1,2) Aspirin and other non-steroidal antiinflammatory drugs (NSAIDs) (generally ibuprofen and indomethacin) should be used as first-choice drugs for the treatment of AP. 3) In addition, colchicine, steroids, azathioprine, intravenous immunoglobulin (IVIG), or antiinterleukin (IL)-1 therapy are considered in cases of intractable PE.…”

“…3) In addition, colchicine, steroids, azathioprine, intravenous immunoglobulin (IVIG), or antiinterleukin (IL)-1 therapy are considered in cases of intractable PE. [1][2][3][4] To determine the optimal treatment for each patient, immunological assessments of PE have been performed in previous studies. [7][8][9][10] However, those studies mainly targeted adult populations with non-IP.…”